Dealing with Challenging Behaviours

With Jayne Harvey

The Supportive Therapy Model

Supportive Therapy is a comprehensive behaviour management program

encompassing a full range of functional assessment tools, programming options and care practices developed over 20 years of qualitative research and implementation.

Dementia is the primary focus for this model, however many of the concepts and tools are applicable for other types of clients as well.

The Supportive Therapy: Philosophy

The person is suffering from brain damage.

If what you are doing for this client is not working,

Then change what you are doing

Because the client cannot change.

The Supportive Therapy: Principles

To define the individual’s strengths (what the individual is still capable of doing) and maintain them.

To define the individual’s limitations (what the person can no longer do) and compensate for them.

To define the areas of vulnerability (the stressors the individual cannot tolerate) and intervene.

The Supportive Therapy: Objectives

1. Provide safe & secure environment for wandering client2. Provide consistency in routines and staff3. Establish a philosophy specific to needs of dementia4. Develop specific care process involving ongoing

analysis & assessment of functioning ability.5. Provide specific social & activity programs geared to

cognitive functioning ability6. Train staff in approach, communication, assessment &

understanding to work with those living with dementia 7. Provide mechanism to define individual vulnerability 8. Provide environment adapted to the needs of client

Behavioural Changes.

Why or when does behaviour become challenging?

Frustration

Reality Orientation

Pain

Medication

Challenging competency

Brain Deterioration

Confusion

Fear

Isolation

Boredom

Fast & Easy InterventionsThings to remember: Meaningful & successful interventions aren’t complex Engage client in helping activity of helping ( feel needed) Use & talk about things you like, know & understand Keep it simple, e.g. baking Throw away your desire to be perfect Be flexible & let client lead intervention where they want Be resourceful & have repertoire of interventions Learn & be comfortable with set of open/closed

questions Most questions can be asked in either style. Modify according to client ability KNOW YOUR CLIENT

Fast & Easy Interventions cont.

Closed Ended Questions: yes/no answers

Open Ended Questions: more elaborate answers

Do you like baking?

Are you a good baker?

Did you ever have a baking fiasco?

Did you buy store bought cookies or bake your own?

What do you like about baking?

What are some of your specialties?

Tell me about a time when your baking when wrong?

What types of cookies did you bake?

Sensory Specific Interventions

Visual Clear and bright pictures (stored in a binder

theme sorted) Original and different jewelry or clothing Coffee table books

Auditory Singing Mimicking sounds and voice patterns (tongue

twisters)

Sensory Specific Interventions cont.

Tactile

Material swatches

Tactile apron

Stress balls

Water logs

Olfactory

Essential oils

Nature items (grass, flowers)

Gustatory

Candies

Fruit

Cognitive Specific Interventions

Quickie Quizzes

Using alphabet & topic, find word for every letter

Days of the week

Special days in each month

Spelling bee

Math calculations

Times tables

Adding sums

Activities of Daily Living Interventions

Kitchen Setting tables Washing/drying dishes

Housekeeping Dusting Carpet Sweeping Cleaning windows / glass surfaces Wiping off table tops

Activities of Daily Living Interventions

Laundry Folding Hand washing items

Sorting Socks Winding yarn Costume jewelry Jars and lids Junk drawers/clutter cupboards

Activities of Daily Living Interventions

Clerical work Removing stamps from envelops Opening mail for the boss (save your junk

mail)

Reminiscent Specific Interventions

Reciting Nursery rhymes Poems Saying and slogans

Restraints

Why do we use restraints?

Safety

Prevent interference with medical devices

Reducing staff stress and involvement

Restraints cont.

What types of restraints are there?

Physical restraints: hand mitt, bed restraint, arm restraint, vest restraint

Mechanical restraints: wheelchair tables, wheelchair footrests

Environment restrains; locked doors, Dutch doors

Chemical/pharmacological restraints: drugs

Restraints cont.

What are some of the risks associated with the above restraints?

1.

2.

3.

4.

5.

Restraints cont.

What We Can Do to Avoid Using Restraints Assess client to understand the message

behind the behaviour Brainstorm interventions or strategies List the interventions Try the first intervention (and on down the list

til the appropriate one surfaces Document results Re-assess

FCS International158 Casimir St, Suite 200Port Perry, ON L9L 1B7

Ph 905-985-6811www.fcsinternational.com